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FORM C-42. Employer. List at least three physicians and provide this panel to employee upon the report of a workplace injury. Keep the completed, signed version of this form on file and send a copy to the employee for their records. Do not send this form to the State unless requested. Employee.
Medical Panel. Employers should offer injured workers a panel of physicians when a work-related injury is reported via the "Employee's Choice of Physician" Form. Required by Law. Most Tennessee employers are required by law to provide a panel of physicians within three business days of receiving notice of a work-related injury.
Medical treatment for your work-related injury is provided at the employer's expense. Sign an Employee's Choice of Physician (Form C-42), which should be provided to you by your supervisor, to indicate which doctor you select to become the authorized treating physician.
FORM C-42. Employer. List at least three physicians and provide this panel to employee upon the report of a workplace injury. Keep the completed original form on file and send a copy to the employee for their records. Do not send this form to the State unless requested. Employee.
Roane County Government - FORM C-42. Employee's Choice of Physician - Medical Panel. Employer. List at least three physicians and provide this panel to employee upon the report of a workplace injury. Keep the completed original form on file and send a copy to the employee for their records. Do not send this form to the State unless requested.
Tennessee Enacts New Medical Panel Form (C-42) and New Telehealth Regulations Efective October 19, 2021. Tennessee adopted a change on October 19, 2021 that afects the TN C-42, the mandatory medical panel which must be provided by the employer at the time of injury.
It is a crime to knowingly provide false, incomplete or misleading information to any party to a workers' compensation transaction for the purpose of committing fraud. Penalties include imprisonment, fines and denial of insurance benefits.
